[Acute pancreatitis--the current state of surgical treatment]

In the beginning of this century the "early operation" in acute pancreatitis was widely used. The irreversibility of the local necrosis and the failure of conservative treatment again lead to the application of this procedure. Early operation is indicated when the pancreatitis shows a more severe degree and when there is no success on conservative therapy or even deterioration in the patient's condition. Early operation means digital removal of the necrosis and/or resection of the pancreas, procedures on the biliary tract, methods for suppression of the secretory activity and installation of jejunal fistulas for external feeding. The mortality rate of partial necrotizing pancreatitis was lowered by this means. In case of total necrosis the mortality was still about 100%. In the postacute stage complications such as sequestration, abscess formation, sepsis, hemorrhage, fistulas can arise. In some of these complications only a "delayed operation" is successful. If a biliary acute pancreatitis was not early and definitively treated, the causative diseases of the biliary tract have to be cured in the postacute stage.